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MattiSeppänen

Lacrimal Duct Stenosis

Lacrimal duct stenosis in a child

  • Tears flow along the lacrimal duct from the eye to the nose and further to the throat. If the lacrimal duct is blocked, tears flow onto the cheek.
  • In children, lacrimal duct stenosis may be congenital.

Symptoms

  • Symptoms often starting at the age of 2-4 weeks
  • Watering of the eye continuously or from time to time
  • The conjunctiva easily become infected with consequent discharge from the eye
  • Redness around the eye

Findings

  • Often conjunctivitis
  • The lacrimal punctum may be smaller than normal or displaced away from the ocular surface.
  • Fluorescein test: a drop of fluorescein dye applied to the eye should normally disappear from the eye within 5 minutes and dye should appear in the nostril of the same side as a sign of a patent lacrimal drainage system. An abnormal finding suggests lacrimal duct stenosis.

Treatment

  • The parents should be taught how to perform lacrimal duct massage.
    • Press the medial corner of the eye with a cotton-tipped swab 4-5 times a day, wipe off the discharge that eventually emerges from the lacrimal duct.
    • Chloramphenicol drops should only be used if there is definite purulent discharge from the eye.
    • The treatment should be repeated every time the eye starts clearly watering or producing purulent discharge.
  • If tearing and purulent discharge still continue at the age of over one year, the child should be referred to an outpatient ophthalmology clinic for probing under general anaesthesia Probing or High-Pressure Irrigation for Nasolactimal Duct Obstruction in Infants.
  • In severe cases, a silicone tube is inserted in the lacrimal duct.
  • For older children, dacryocystorhinostomy is considered.

Lacrimal duct stenosis in an adult

Symptoms

  • Tearing and purulent discharge from the eyes
  • Recurrent ophthalmia

Findings

  • Pus or phlegm emerging from the lacrimal punctum on palpation suggests stenosis of the lower lacrimal duct.
  • If a lump is detected on palpation, a tumour should be considered, particularly if the lump is hard or of an abnormal shape, attached to bone or causes malposition of the eyeball.
  • If the lacrimal punctum area is red and irritated and white fluid emerges when squeezing it, there may be canaliculitis.
  • Marked resistance or flow obstruction on lacrimal irrigation indicates partial or complete obstruction.

Treatment

  • The patient should usually be referred to an ophthalmologist for diagnosis confirmation and treatment.
  • In an adult, lacrimal irrigation can also be performed by a general practitioner if he or she has the necessary knowledge and skills and the right equipment.
  • In lacrimal duct stenosis, insertion of a silicone tube is often sufficient. In complete obstruction, surgical intervention is often necessary.

    References

    • Ali MJ. Etiopathogenesis of primary acquired nasolacrimal duct obstruction (PANDO). Prog Retin Eye Res 2023;96():101193 [PubMed]
    • Leivo T. [Lacrimal duct stenosis]. In: Seppänen M, Kaarniranta K, Setälä N, Uusitalo H (eds.). [Handbook of Ophthalmology]. 3rd revised edition. Duodecim Publishing Company 2022. Available in Finnish.
    • Ali MJ, Paulsen F. Etiopathogenesis of Primary Acquired Nasolacrimal Duct Obstruction: What We Know and What We Need to Know. Ophthalmic Plast Reconstr Surg 2019;35(5):426-433 [PubMed]
    • Vagge A, Ferro Desideri L, Nucci P, et al. Congenital Nasolacrimal Duct Obstruction (CNLDO): A Review. Diseases 2018;6(4): [PubMed]
    • Petris C, Liu D. Probing for congenital nasolacrimal duct obstruction. Cochrane Database Syst Rev 2017;7(7):CD011109 [PubMed]